How well do we consider equity in efficiency analysis studies of vaccines? A systematic review of equity-informative economic evaluations of vaccines
2Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Switzerland
The Immunization Agenda 2030 prioritizes the populations without access to vaccines. Health equity has been increasingly incorporated into economic evaluations of vaccines to foster equitable access. Robust and standardized methods are needed to evaluate health equity impact of vaccination programs to ensure monitoring and effective addressing of inequities. However, methods currently vary and potentially affect the application of findings to inform policy decision-making.
Objectives: To identify and summarize economic evaluations of the health equity impact of vaccines and immunization programs, focusing on the methods and applications.
Methods: We searched PubMed, Embase, Econlit, and CEA Registry up to December 15, 2022. We included articles that met the following eligibility criteria: full-text articles of economic evaluations estimating costs, outcomes, and health equity impact of vaccines across equity-relevant subgroups in any context. We summarized how health equity was incorporated and evaluated in the selected studies. We performed reporting quality assessment using the Consolidated Health Economic Reporting Standard (CHEERS) 2022 statement.
Results: Twenty-one studies were included that performed health equity impact analysis to estimate the distributional impact of vaccines, such as deaths averted and financial risk protection, across equity-relevant subgroups. Eleven studies performed only health equity impact analysis as part of cost-effectiveness analyses to estimate the distributional impact and subpopulation incremental cost-effectiveness ratios of vaccines. Nine studies are Extended Cost-Effectiveness Analyses (ECEAs) that performed health equity impact analysis of vaccines with an estimation of the distributional financial risk protection. One study is a Distributional Cost-Effectiveness Analysis (DCEA) that performed a health equity impact analysis of vaccines incorporating equity-weighting and opportunity costs as the money was displaced to be spent on vaccines instead of other health services. These studies showed similar findings that introducing vaccines or improving vaccination coverage resulted in fewer deaths and higher financial risk benefits in subpopulations with higher disease burdens and lower vaccination coverage, particularly poorer income groups and those living in rural areas.
Conclusions: Methods to incorporate equity have been evolving progressively. Vaccination programs can enhance equity if their design and implementation address existing inequities in order to provide equitable vaccination coverage and achieve health equity. Patient, public, and/or healthcare consumer involvement: None.